Blood Transfusion and Intravenous Infusion – Clinical Skills



the transfusion of blood is one of the most potentially dangerous events that can occur in a hospital this video will explain all aspects of the procedure involved in safely transfusing blood on the ward we'll also demonstrate how to set up an IV infusion this video will not cover blood transfusions in emergency settings in operating theatres or in other special circumstances as different protocols will be required for similar reasons this video will only focus on the transfusion of blood and not cover the transfusion of other blood products such as platelets and fresh frozen plasma in this scenario the patient is on the ward following an upper GI bleed the patient is tired and out of breath oxygen saturation is 92% on room air and the respiratory rate is 28 pulse is 110 beats per minute and blood pressure is 105 over 60 blood tests share the hemoglobin concentration to be seven point eight grams per deciliter and a decision to transfer use one unit to the blood has been made as a rule of thumb one unit of transfused blood will raise hemoglobin concentration by one gram per deciliter and the target concentration should be between eight to ten grams per deciliter based on their vital signs it has also been decided that the patient should have an IV infusion of normal saline while awaiting blood the equipment required before this procedure is showing wash your hands introduce yourself to the patient and ask for their name and date of birth confirm this by looking at the patient and their and their wristband explain the reason for the blood transfusion and the associated risks benefits and possible alternatives to them so the main reason we're going to give you the blood is to make you feel better and you'll find that hopefully it will resolve your symptoms quite quickly such the shortness of breath and the tiredness now although the blood we giving you is screened there is a small risk of infection from hepatitis B hepatitis C HIV and there's also a small chance that there might be some transmission or variant CJD as well more details of that can be found in the patient information leaflet there is also a small chance that your body might have a negative reaction to the blood but we'll be keeping a close eye on you during and after transfusion to make sure that if it does happen we're well prepared does that sound okay to you do I have your permission to proceed and here's the patient information leaflet verbal consent is sufficient although it is good practice to document their consent in the patient notes a patient information leaflet should also be made available blood transfusions need to be prescribed and must be written up on the patient's drug chart in the designated transfusion section it's important to write the clinical details at this stage just in case it is someone else who later has to administer the blood so they have the correct information make a note of the number of units to prescribe and whether there are any special requirements such as CMV negative blood or irradiated blood fill in a blood request form carefully details that are essential for the blood bank to efficiently process the request include surname first name date of birth gender unique patient number or hospital number specific location of the patient ie Hospital and ward or clinic and where blood is required patient's diagnosis reason for transfusion data blood required transfusion history number of units of red cells and any special requirements such as CMV negative radiated data requests and signature of member of staff making the request before collecting the blood sample check the patient's identity on their wristband make sure this corresponds to the information in the request form use correct venipuncture technique to fill a full blood count bottle some trusts use an automated safe TX system to order and administer blood if this is the case the same principles of checking patient identity reply follow the on-screen instructions which involves scanning the patient's wristband bar code to generate labels for the request form and blood bottle finally send the sample to the blood transfusion lab if blood is required urgently also called the lab to flag this as so in this scenario based on their vital signs it has been decided that the patient should have some fluid resuscitation while waiting for the blood transfusion lab to process the blood requests before setting up the IV infusion wash your hands put on a pair of gloves and obtain venous access using a cannula flush through with five mils of saline next prepare your equipment tray to give an IV infusion since blood will be given scene a blood giving set is more appropriate to use in this situation than the standard IV giving set normally used for say nine infusions of blood giving set differs in that it has a mesh filter incorporated and can also give a faster flow rate wash your hands and clean the amt tea tray open the blood giving set and IV fluid in this case say line onto the tray break off the cover on the SE line bag and hang it on a drip stand close off the clamp and the blood giving set remove the protective cover of the giving set spike and pierce the saline bag ensuring that the spike is fully in squeeze the drip chamber a few times until it half fills with saline then open the clamp so that the say line runs through when fluid reaches the end close the clamp and attach the end of the line to the clamp the final stage involves connecting the line to the cannula first clean the one-way injection port with a chlorhexidine wipe and wait 30 seconds for it to dry then remove the protective cap from the end of the line and connected to the one-way injection point start the infusion by opening the clamp right up the infusion in the patient's drug chart and fluid balance chart it is important to take some observations no more than 60 minutes before starting the transfusion these pre-transfusion vitals are pulse blood pressure respiratory rate and temperature write them up in the patient's observation chart check if the blood is ready using the online system unless this is an urgent request in which case the blood transfusion lab will contact the ward arrange for reporter to collect the blood the time of removal of the blood from the blood fridge will be written in the blood collection slip from this moment the clock is ticking and transfusion needs to commence within 30 minutes and finished within four hours perform a patient identity check once more check that the surname first name date of birth hospital number and gender are the same on the patient's identity bracelets the compatibility label attached to the blood bag the prescription chart and/or patient medical notes if there is any discrepancy do not continue inform the blood transfusion laboratory and wait until the discrepancy is resolved if using the automated safety X system follow the on-screen instructions these will instruct you to scan the barcode on the compatibility label and then scan the patient wristband barcode a discrepancy will trigger an alarm next perform pre-transfusion checks on the blood to be transfused check that the blood group and unit number on the bag are identical to those on the compatibility label attached to the blood bag the blood has not passed his expiry date the blood bag shows no signs of damage and that there is no evidence of leakage the units of blood or platelets complies with any special requirements for transfusion finally write the unit number on the action shot right the date and time of the transfusion and sign it blood is now ready to be given wash your hands and put on a pair of gloves put up the bag of blood on a drip stand then remove the spike of the blood giving set from the saline bag and insert it into the bag of blood ensuring it is fully in adjust the regulation clamp to attain the desired rate of blood flow clearly indicate the time the transfusion chart starts and the unit number on the observation chart ask the patient to report any potential adverse effects so the main symptoms that I'd like you to tell us about or is if you get any shivering that you feel flushed if you have any rashes if you get to be paying and your extremities or your loins or to generally feeling unwell severe transfusion reactions are most likely to occur during the first half hour of transfusion of each unit of blood so checked on check on the patient 15 minutes from the beginning of the transfusion record the pulse blood pressure respiratory rate and temperature if a transfusion reaction is suspected stop the transfusion and seek senior advice once the transfusion ends record the time on the observation chart and repeat vital observations observe the patient over the next 24 hours for late adverse reactions counseled the patient about the possibility of these if they are discharged find you finally document the transfusion in the patient's notes important details to include other date of transfusion clinical indication for the transfusion type of blood component or product to used the number units used transfusion reactions and their management comments about the effectiveness of the transfusion for example relief symptoms of anemia you you

20 comments

  1. He used the same Iv transfusion set in the Blood bag . There's specific Iv set for Blood transfusion, must not use the Iv set used in Pnss.

  2. I was told last week that I needed a blood transfusion because my hemoglobin was at 7.7, then dropped to 6 overnight. The hospital did not give me any information at all! I had to ask all of the questions. They just kept saying I should do it.
    It was the strangest experience ever! I refused the transfusion, and I am so happy that I did.

  3. Thank you for the reminder about cleaning your hands and wearing gloves. It is important to prevent hospital acquired infections. I enjoyed the video.

  4. There is something wrong. We don't use the same IV set firstly and the second thing is BT set has filter too.

  5. this is something wrong not use iv set nd used bt set and not use iv line hands another hands use

  6. i believe it is also important to verbally confirm the patient's identity and not just totally rely on his/her wristband..

  7. Informed consent for America has to be written, witnessed, and signed either by the patient or the patient's family. Just letting people know who are watching this in the US.

  8. regarding the IV infusion, there's no extension set? very rarely have I seen IV infusion straight into the cannula (but i suppose it could be done), and you'd have to flush the cannula first to check patency. and tape the drip to the arm, right?

  9. I had a blood transfusion on me when I was born there there wires put in my body apparenttly so I would survive death

  10. +Mors Magne Absolutely. An Hb of 8 is generally considered a reasonable trigger for transfusion in a patient with few co-morbidities. However, this should always be adapted to the individual. For example, a patient with heart disease may require an Hb >8 and a patient with sickle cell disease will likely be able to tolerate an Hb <8. 

  11. I don't agree with the target Hb. This should depend on the patient. For example, if they are elderly or have heart disease, they will require a higher Hb than 8.

Leave a Reply

(*) Required, Your email will not be published